单切口切开复位内固定治疗胫腓骨远端骨折

Internal Fixation of Plate for Distal Tibiofibular Fractures via Single Incision

目的探讨单切口切开复位钢板螺钉内固定治疗胫腓骨远端骨折的疗效。方法回顾性分析2015年8月~2018年9月我院骨科收治的46例胫腓骨远端骨折患者的临床资料,均为闭合性骨折,均行切开复位钢板螺钉内固定。其中,23例采用单切口入路(观察组),23例采用双切口入路(对照组)。记录并比较两组手术、骨折愈合、并发症情况,采取Johner-wruhs评分评价临床效果。结果两组均顺利完成手术,观察组出血量、手术时间及骨折愈合时间均优于对照组,差异有统计学意义(P<0.05)。随访6~18个月,平均(14.72±2.66)个月,所有患者均未发生感染、骨不连、血管神经损伤、骨折畸形愈合,下肢力线均得到很好纠正,膝关节、踝关节、距下关节运动范围好,无痛,步态正常。Johner-wruhs评分均达到优良。结论单切口行钢板螺钉内固定治疗胫腓骨远端骨折创伤小,可缩短手术时间,减少出血,促进骨折愈合,降低术后感染发生率,临床效果可靠,且操作简单,易于掌握。

Objective To investigate the effect of open reduction and internal fixation of plate screw via single incision for treatment of the distal tibiofibular fractures.Methods From August 2015 to September 2018,a total of 46 patients with closed distal tibiofibular fractures in our department were analyzed retrospectively,including 23 cases treated by open reduction and plate screw internal fixation via single-incision(as the observation group)and 23 cases by open reduction and plate screw internal fixation via double-incision(as the control group).The clinical results were evaluated by Johaer-wruhs scores.The peri-operative result,fracture healing,clinical result and complications were recorded and compared between the two groups.Results All operations were accomplished successfully.The blood loss volume,operation time and fracture healing duration of the observation group were less than those of the control group,and all the differences were significantly(P<0.05).After 6 to 18 months follow-up,there was no infection,fracture union,injuries of vessel and nerve,deformed healing in both groups.The line of force was corrected in lower extremity,good movement was achieved at knee,ankle and subtalar joint,and the clinical outcome revealed excellence by Johner-wruhs sore.Conclusion The open reduction and internal fixation of plate via single-incision is a simple,mini-trauma,and effective treatment for distal tibiofibular fractures with short operation time,less bleeding,accelerating fracture healing and lower infection incidence after the surgery.